Strengthening Rural Health In Southwest Washington

Strengthening Rural Health In Southwest Washington

Applications may be submitted via video if you prefer, please limit your video submission to no more than 10 Minutes. Please send video files and all other application information to communications@southwestach.org
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Yes
Name of organization*
Mission or purpose of organization*
Organization's website*
Point of contact name*
Point of contact email*
Point of contact phone number*
Project manager name*
Project manager email (if different than point of contact)
Project manager phone number (if different than point of contact)
Fiscal point of contact name*
Fiscal point of contact email (if different than point of contact or project manager)
Fiscal point of contact phone number (if different than point of contact or project manager)
Application written by*
Your name
What is your job title?*
501(c)3 EIN (if applicable)
Total amount of funding requested*
Name of program funds will go towards (if applicable)
Please upload a proposed budget (including timeframe, project deliverables and activities grand funding will support)*

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Demographic Information
What rural geographic areas do you support by county?*

ClarkSkamaniaKlickitat
If Clark County, what is the city, cities, and/or zip codes of the areas served.
How do the areas served by your agency meet the definition of rural?*
What experience does your agency have working with rural communities?*
What community/communities does your organization serve?*
Is your organization led and managed by and for the community which it serves?*

YesNo
Describe how your organization is connected to the community/communities it serves*
What rural health needs are served by your agency?*
What barriers to providing services is your agency seeking to overcome?*
What race/ethnicities/language and demographic identities are prioritized by your agency for this project? *
Any additional information you'd like to share about the demographics for your project?*
Project or Initiative
Provide a brief description of what this project or initiative will focus on, what the funds will be used for, and how funds will align with funding goals. Please include:
Has your organization received funds for this project or initiative in the past (if yes, please describe)? Is this project or initiative to maintain an existing project, start or new project, or expand on a current project? How will this project or initiative strengthen rural health needs?*
What is the problem, gap, or unmet need this project or initiative will be addressing? What are your intended outcomes and how will they be measured?*
How will funding impact both the organization and the community/communities the organization serves?*
What organizational challenges or barriers would this address for your organization?*
What community partnerships does your organization currently have and how will your organization collaborate with other community organizations to meet program goals?*
Anything else you would like to share?
Organization Readiness and Alignment
Describe how funds will meet the funding goals within the contract duration and how the organization will sustain work past the end of the contract*
Describe how your organization aligns with SWACH's mission, values, and the priorities highlighted in the proposal.*
Anything else you'd like to share?
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Strengthening Rural Health In Southwest Washington

Demographic Information

Project or Initiative

Organization Readiness and Alignment